Application of 3D Rapid Prototyping Technology in Posterior Corrective Surgery for Lenke 1 Adolescent Idiopathic Scoliosis Patients

Abstract

A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients.3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients.Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle <50° and mean Cobb angle >50°. Besides, economic evaluation was also compared between 2 groups.A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P < 0.001). However, no significant differences were observed in complication rate, length of hospital stay, and postoperative radiological outcomes between 2 groups (all, P>0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate of pedicle screws was observed in patients whose mean Cobb angle was >50° (9.15% vs 13.03%, P = 0.02). Besides, using 3DRP increased the economic burden of patients (157,000 ± 9948.85 Ren Min Bi (RMB) vs 152,500 ± 11,445.52 RMB, P = 0.03).Using the 3D printing technology before posterior corrective surgery might reduce the operation time, perioperative blood loss, and transfusion volume. There did not appear to be a benefit to using this technology with respect to complication rate and postoperative radiological outcomes; however, 3D technology could reduce the misplacement rate in patients whose preoperative mean Cobb angle was >50°. Besides, it also increased the patients’ hospital cost. Therefore, future prospective studies are needed to elucidate the efficacy of this emerging technology.

Systematic review of 3D printing in spinal surgery: the current state of play

“…The improved visualization and preparation afforded by the use of individualized models has clinical benefits, with reduced operation time and perioperative blood loss being most commonly reported (11,13,14,(21)(22)(23)(26)(27)(28)30). Reduction in operation time of 15-20% has been reported in multiple studies (11,14,23) across various surgical procedures.…”

“…The main reasons given for reduced operation time included a more evolved understanding of the pathology, such as location and surgical approach, and the facilitation of pre-operative instrumentation decisions (14,16,(18)(19)(20)(21)24,27,28,50). Other clinical benefits such as improved diagnosis, reduction in fluoroscopy time, better communication within the surgical team and lower rates of screw misplacement have been reported when compared with the use of conventional imaging in pre-operative planning (11,14,20,26,30). Izatt et al (14) found that the use of a 3DP biomodel improved surgical outcomes in 78% of cases, though this is contradicted by Li et al (23) who reported no change in complication rates or clinical outcomes.…”

“…In the studies reviewed, time taken to create the models ranged from 5 hours to 2 days, with extra costs anywhere between $300 and >$1,000 (10,11,13,18,20,22,26,27). Izatt et al (14) stated that these additional costs were offset in 59% of cases by the more Figure 1 Flow chart of literature search performed using PRISMA methodology (9).…”

“…A full-scale, stereoscopic understanding of the pathology allows for more detailed planning and simulation of the procedure (10)(11)(12)(13)(14)(15)(16)(17)(18)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(50)(51)(52). Assessing complex pathologies on a model overcomes many of the issues associated with traditional 3D imaging, such as the lack of realistic anatomical representation and the associated complexity of computer-related skills and techniques (10,12).…”

Cardiothoracic Applications of 3-dimensional Printing

“…The models had no effect on complication rates, postoperative radiological outcomes or length of hospital stay, and resulted in a 3% overall increase in cost per patient. However, operating room (OR) time was reduced by 13% (184 versus 212 min with versus without models) and blood loss was reduced by 18% [14]. This perhaps highlights an administrative incentive for introducing a clinical 3D printing service in an academic hospital at present, namely performing more operations in a day without reducing the quality of care.…”